Inguinal Hernia in Children

What is an inguinal hernia?

A hernia occurs when a section of intestine protrudes through a weakness in the abdominal muscles. A soft bulge is seen underneath the skin where the hernia has occurred. A hernia that occurs in the groin area is called an inguinal hernia.

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What causes an inguinal hernia?

A hernia can develop in the first few months after the baby is born because of a weakness in the muscles of the abdomen.

As a male fetus grows and matures during pregnancy, the testicles develop in the abdomen and then move down into the scrotum through an area called the inguinal canal. Shortly after the baby is born, the inguinal canal closes, preventing the testicles from moving back into the abdomen. If this area does not close off completely, a loop of intestine can move into the inguinal canal through the weakened area of the lower abdominal wall and cause a hernia.

Although girls do not have testicles, they do have an inguinal canal, so they can develop hernias in this area as well.

Who is at risk for developing a hernia?

Hernias occur more often in children who have one or more of the following risk factors:

A parent or sibling who had a hernia as an infant

Cystic fibrosis

Developmental dysplasia of the hip

Undescended testes

Abnormalities of the urethra

Who is affected by inguinal hernias?

Inguinal hernias occur:

In 1% to 5% of full-term infants

In 9 % to 11 % of premature infants

In children who have a family history of inguinal hernias

More often in infants and children with other urogenital anomalies

More often in the right groin area than the left, but can occur on both sides

Occasionally, the loop of intestine that protrudes through a hernia may become stuck, and is no longer reducible. This means that the intestinal loop cannot be gently pushed back into the abdominal cavity. When this happens, that section of intestine may lose its blood supply. A good blood supply is necessary for the intestine to be healthy and function properly.

What are the symptoms of an inguinal hernia?

Hernias usually occur in newborns, but may not be noticeable for several weeks or months after birth. Straining and crying do not cause hernias; however, the increased pressure in the abdomen can make a hernia more noticeable.

Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries, and may get smaller or go away when the baby relaxes. If your doctor pushes gently on this bulge when the child is calm and lying down, it will usually get smaller or go back into the abdomen.

If the hernia is not reducible, then the loop of intestine may be caught in the weakened area of abdominal muscle. The following are the most common symptoms that indicate this has occurred. However, each child may experience symptoms differently. Symptoms may include:

A full, round abdomen

Vomiting

Pain or fussiness

Redness or discoloration

Fever

The symptoms of an inguinal hernia may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How is an inguinal hernia diagnosed?

Hernias can be diagnosed by a physical examination by your child's doctor. Your child will be examined to determine if the hernia is reducible (can be pushed back into the abdominal cavity) or not.

What is the treatment for inguinal hernias?

Specific treatment for an inguinal hernia will be determined by your child's doctor based on:

Your child's age, overall health, and medical history

The type of hernia

Whether the hernia is reducible (can be pushed back into the abdominal cavity) or not

An operation is necessary to treat an inguinal hernia. It will be surgically repaired fairly soon after it is discovered, since the intestine can become stuck in the inguinal canal. When this happens, the blood supply to the intestine can be cut off, and the intestine can become damaged. Inguinal hernia surgery is usually performed before this damage can occur.

During a hernia operation, your child will be placed under anesthesia. A small incision is made in the area of the hernia. The loop of intestine is placed back into the abdominal cavity. The muscles are then stitched together. Sometimes, a piece of meshed material is used to help strengthen the area where the muscles are repaired.

What is the long-term outlook for an inguinal hernia?

Once the hernia is closed, either spontaneously or by surgery, it is unlikely that it will reoccur. Reoccurrence of the hernia happens slightly more frequently if the intestine was damaged.